Provider Demographics
NPI:1053433714
Name:CUSTOM REHAB NETWORK
Entity type:Organization
Organization Name:CUSTOM REHAB NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLINEHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-747-5846
Mailing Address - Street 1:451 ASPINWALL DR
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3902
Mailing Address - Country:US
Mailing Address - Phone:707-746-5581
Mailing Address - Fax:
Practice Address - Street 1:451 ASPINWALL DR
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3902
Practice Address - Country:US
Practice Address - Phone:707-747-5846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment